2004 Behavioral Risk Factor Surveillance SystemRisk Factor Surveillance System (BRFSS) survey for Williamson County in an effort to assess and understand the health behaviors and associated

Williamson County, Texas

2004 Behavioral Risk Factor Surveillance System Report on the Williamson County 2004 BRFSS Survey

Williamson County, Texas

2004 Behavioral Risk Factor Surveillance System

Table of Contents

Section I: Report on the Williamson County 2004 BRFSS Survey .............................. 1-13

Section II: Tables and Graphs for Common Health Indicators & Risk Factors ............ 1-13

Section III: Data Tables .................................................................................................. 1-29

Appendix A: Technical Documentation & Questionnaire.................................................. 1-27

Appendix B: Census and BRFSS Demographic Data ........................................................ 1-2

Appendix C: Healthy People 2010 Comparative Indicators .............................................. 1-4

Section I

Report on the Williamson County 2004 BRFSS Survey

Williamson County 2004 BRFSS Section I, Page 1

Williamson County Behavioral Risk Factor Surveillance System (BRFSS) Introduction In 1999 the Williamson County and Cities Health District (WCCHD) implemented the first Behavioral Risk Factor Surveillance System (BRFSS) survey for Williamson County in an effort to assess and understand the health behaviors and associated risks of county residents. This effort continues with the release of the 2004 Behavioral Risk Factor Surveillance System (BRFSS) survey results.

This report provides information on the results of the BRFSS survey conducted in Williamson County during the summer of 2004. The survey was conducted to gather information on a variety of health indicators and risk factors that can impact health in both positive and negative ways, including smoking, exercise and diet, access to medical care, dental health, quality of life, chronic disease, neighborhood, and public health emergency. These data help WCCHD and our public health partners determine priority health issues and identify populations at highest risk, develop strategic plans and target prevention programs, monitor the effectiveness of intervention strategies, educate the public and policymakers about disease prevention, and support community policies that promote health and prevent disease.

Information in this report provides a broad picture of the of the 2004 BRFSS results for Williamson County with comparisons between East and West Williamson County. The survey yielded a wealth of additional information which allows in many cases for comparisons by demographic characteristics such as age group, race/ethnicity, gender and income in the county. Over the next year, WCCHD will be publishing and publicizing information from the survey highlighting demographic differences in relation to the measured behavioral risk factors. WCCHD also invites all partners in public health to use the Williamson County BRFSS data to assist in public health initiatives.

BRFSS Background

The BRFSS is a population-based phone survey sponsored by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services. The BRFSS was initiated by CDC in some states in 1981; Texas began participating in 1987. In the 1990s, several counties and other communities in Texas sponsored surveys to gather data at the local level. BRFSS survey data has been widely used to monitor health behavior and health status at the state and national levels, and provides important information for the development of public health programs. Detailed information on the BRFSS can be found on CDC’s website (http://www.cdc.gov/brfss/), on the Department of State Health Services (DSHS) Texas BRFSS website (http://www.tdh.state.tx.us/chs/brfss/brfss_home.htm), and on WCCHD’s website (www.publichealthwilliamson.org). In 2004, WCCHD contracted for the BRFSS to be conducted for the second time in Williamson County. The first Williamson County survey was conducted in 1999. DSHS supervised the 2004 survey with technical assistance provided by CDC. The telephone surveys were conducted by Clearwater Research,


Inc. of Boise, Idaho. Mary Young, PhD, Professor of Economics at Southwestern University conducted the initial data analysis and Dan Hilliard, PhD, Professor of Sociology at Southwestern University provided feedback on the draft report and conclusions. The Community Assessment Team in the Center for Health Statistics at DSHS provided additional data analysis and assistance to WCCHD in the preparation of this final report. Funding support for the survey was provided by DSHS, Georgetown Healthcare System, Johns Community Hospital, Seton Healthcare Network, Scott and White, Round Rock Medical Center, and the Greater Williamson County and Georgetown Area United Ways.

Survey Method

The BRFSS survey is a confidential telephone survey of a sample of adults 18 years of age and older in households with telephones. The BRFSS questionnaire is designed by a working group of state coordinators and CDC staff. There are three components from which questions from this survey are derived: 1) core component questions, 2) optional modules, and 3) state-added questions. WCCHD and staff selected the modules/questions used in this survey. The Williamson County survey includes questions that measure 17 different health indicators and risks, as well as demographic information about the survey participants. There were a total of 66 questions. A copy of the questionnaire is available as Attachment 1 in Appendix A.

The BRFSS data are adjusted, or “weighted”, so that the survey results approximate the age, gender, and racial/ethnic distribution for Williamson County, not just those who responded to the survey. Data weighting is a statistical process that includes the consideration of factors such as the number of residential telephones in the household, the number of adults in the household, and a stratification process (the separation of groups of individuals into subgroups according to specific characteristics) for age, race, and gender distribution.

The Williamson County survey was designed to yield not only a sample adequate for analysis of the county as a whole but also a sufficient sample for sub-county analysis of populations for East and West Williamson County (referred to as East County and West County for the remainder of this report). Therefore, East County was deliberately over sampled to compensate for differences in population density. The advantage of this technique is that health indicators and risks behaviors in East County can now be analyzed in greater detail with the 2004 sample than was possible with the 1999 sample.

For the 2004 survey, East County was defined by 8 zip codes that include the cities of Hutto, Taylor, Granger, Thrall, and Coupland. West County was defined by 14 zip codes that include the cities of Georgetown, Round Rock, Cedar Park, Leander, Florence, Liberty Hill, and Jarrell. A copy of the map of zip codes for the East and West county regions is provided as Attachment 2 in Appendix A.

Survey Sample

The 2004 BRFSS sample consisted of 827 Williamson County adult residents 18 years of age and older. Residents in East County made up 50.4% (N=417) of the sample. Residents in West County made up the remaining 49.6% (N=410).

By comparison, the 1999 BRFSS was based on a sample of 1,281 residents. The data were categorized into four areas: Cedar Park, Georgetown, Round Rock and Taylor/East Williamson County. The cities in West County represented 88.8% (N=1,138) and East County represented 11.2% (N= 143) of respondents. In the 1999 survey, this distribution corresponded closely with the actual population distribution in Williamson County. A limitation of the 1999 BRFSS was that the sample size in East Williamson County was too small to conduct statistically valid analyses of important health indicators and risk behaviors.


Demographic Characteristics

The demographic characteristics of the survey sample were statistically similar to most of those for Williamson County as identified in the 2000 U.S. Census data. Age, race/ethnicity, marital status, families with children, education, employment, and income were all similar (see Appendix C).

Distribution of Survey Respondents by Age and Gender for Year 2004

Age Williamson County East County West County Census 2000

% % % % 18 to 24 10 8 11 11 25 to 34 25 23 25 24 35 to 44 27 23 27 27 45 to 54 16 16 16 18 55 to 64 12 13 12 9

65+ 11 17 9 11

Source: Williamson County Behavioral Risk Factor Surveillance Survey 2004 Demographic Differences for East County and West County Samples There are several important differences among demographic characteristics between respondents in the East County and West County samples. These differences in demographic attributes are supported by Census 2000 data for Williamson County.

Age: The mean age of the respondents in East County was 4.6 years older than those in the West County sample.

Race/Ethnicity: The racial and ethnic attributes of respondents from the West County and East County regions were different; 24% of respondents in the East County sample identified themselves as non white while only 14% of the West County sample did.

Education: There was diversity in educational levels for the East and West samples. East County results show that 18% reported less than a high school education as compared with 4% in West County. Twenty percent of East County respondents graduated from college compared to 45% from West County.

Income: Results showed significant regional variations in reported household income. Of the East County sample, 30% respondents reported income less than $25,000 per year compared with 17% of the West County sample. Forty percent of West County households identified themselves in the highest income grouping ($75,000+), compared to 17% in East County.


Key Findings Findings for Common Health Indicators & Risk Factors

The Williamson County 2004 survey gathered information on a variety of health indicators and risk factors that can impact health in both positive and negative ways. Refer to Section II for tables and graphs of data discussed in the Key Findings, Section III for tables of all of the response data, Appendix A for technical documentation, Appendix B for demographic data, and Appendix C for Healthy People 2010 information.

The table below shows the findings for 13 common health indicators and risk factors for Texas, the total Williamson County sample, and the East County and West County samples. These 13 indicators are some of those most commonly used by federal, state, and local public health officials in monitoring health status. These items are discussed in more detail in the Summary of Findings. Although there were differences between East County and West County samples for the common health indicators, none of these differences are statistically significant at a 95% confidence interval.

Common Health Indicators & Risk Factors

Texas County East West % CI 95% % CI 95% % CI 95% % CI 95%

Doctor Diagnosed Diabetes 8* (7-9) 8 (6-10) 10 (7-13) 7 (5-10) Diagnosed with High Blood Pressure 24* (23-25) 22 (19-26) 29 (25-34) 21 (17-25)

Taking Medication To Control High Blood Pressure n/a n/a 73 (64-80) 82 (74-89) 70 (58-79) Cholesterol Checked In Past 5 Years 68* (67-70) 78 (74-82) 74 (69-79) 79 (74-83) Diagnosed With High Cholesterol 34* (32-35) 36 (32-41) 31 (25-36) 38 (32-44) Current Asthma (Adult) 7 (6-8) 6 (4-8) 7 (4-10) 6 (4-8) Current Smoker 20 (19-22) 18 (15-22) 19 (15-24) 18 (14-22) Current Use Of Smokeless Tobacco n/a n/a 3 (2-5) 8 (5-11) 2 (1-4) Flu Shot In Past Year, Age 65+ 68 (65-71) 76 (65-84) 75 (64-84) 76 (61-87) Obese1 26 (24-27) 26 (22-30) 26 (22-31) 25 (21-31) Overweight 37 (36-39) 37 (32-41) 38 (33-43) 36 (31-42) Meets Physical Activity Recommendations 44 (42-46) 53 (49-58) 52 (46-57) 54 (48-59)

Meets Recommendations for Fruits & Vegetables 23* (21-24) 22 (18-26) 22 (18-27) 22 (17-26)

Source: Williamson County BRFSS Survey 2004 and the Texas Behavioral Risk Factor Surveillance System 2003, 2004.

*The Texas BRFSS data in this table are from the year 2004 except for those noted with an asterisk (*), which are from the survey year 2003. 1 Obese and overweight are exclusive.

WHAT IS A CONFIDENCE INTERVAL (CI)? Throughout the report, percent estimates and confidence intervals are presented. Percent estimates are estimates of the true population value (eg 13% of adults are current smokers). However, since estimates are based on a sample and not the entire population, there is some error. Confidence intervals take this error into account and present a range in which the “true value” is likely to fall (eg between 11% and 17% of adults are current smokers). A 95% confidence interval means that among 100 samples drawn, 95 will contain the true population value. When confidence intervals for two population estimates do not overlap, the difference between the estimates is considered statistically significant; that is, the difference is unlikely due to chance.


Summary of Findings

This section provides a summary of the findings of the BRFSS survey results. Survey respondents were limited to adults aged 18 years and older. The information is presented in five categories: self-reported health status, chronic conditions, risk factors, health care access, and environment. Results comparing East County and West County samples are not statistically significant unless otherwise stated.

Self Reported Health Status

Self-reported health status is often one of the best indicators of overall physical and mental health. The 2004 Williamson County BRFSS contained four questions about health status. Respondents were asked to rate their general health, to indicate the number of poor physical or mental health days in the past 30 days, and to report how many days in the past 30 days they had not been able to carry out their usual activities because of poor physical or mental health.

Eighty-nine percent of respondents said their health was excellent, very good, or good. A comparison of East and West County samples shows that 90% of respondents in West County and 82% of East County reported their health as ‘excellent’ or ‘very good’. For Texas, 80% of adults said their health was excellent, very good, or good (Texas BRFSS 2004). More respondents in the East County (18%) said their health was ‘fair or poor’ than did those in West County (10%). This difference is statistically significant.

Of the total county sample, 22% said that their mental health was ‘not good’ for 5 or more days during the past 30 days. Twenty-two percent of respondents in the West County sample said that their mental health was ‘not good’ for 5 or more days during the last month while 19% did in East County. Nine percent of respondents reported that poor physical or mental health kept them from doing usual activities, such as work or recreation activities, 5 or more days in the past month. Results were similar for East County and West County samples, 11% and 9% respectively. Chronic Conditions

Chronic conditions are diseases that may limit the ability to perform usual activities, can impair quality of life, and exacerbate other health conditions. The Williamson County 2004 BRFSS asked about four conditions: diabetes, hypertension (high blood pressure), high cholesterol, and adult asthma. Diabetes: Eight percent of the total sample reported that they had been diagnosed with diabetes, a 4% increase from the 1999 BRFSS results. The Texas 2003 BRFSS also reported 8% of the adult population diagnosed with diabetes. Both the Texas and Williamson County BRFSS results are higher than the Healthy People 20101 (HP 2010) target rate of 2.5%. East County results show a higher percentage of diabetes than do results for the West; 10% in the East sample and 7% in the West sample. However, this difference is not statistically significant. High Blood Pressure: Twenty-two percent of all respondents had been diagnosed with high blood pressure. Among those, 73% were taking medication to control it. The HP 2010 goal is to reduce the proportion of adults with high blood pressure to 16%. Texas 2003 BRFSS results show that slightly over 24% of adults had been told they had high blood pressure. Respondents in East County reported more cases of high blood pressure (29%) than did those in West County (21%). Though important, the difference between East and West results for high blood pressure is not statistically significant.

1 U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health and Objectives for Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. [http://www.healthypeople.gov/Document/tableofcontents.htm#parta]


High Cholesterol: Of the total sample, 78% reported having their cholesterol checked within the past 5 years: short of the Healthy People 2010 target of 80% but better than the Texas rate of 68% (Texas BRFSS 2003). The Healthy People 2010 target for the number of adults with high total blood cholesterol levels is 17%. For Williamson County’s 2004 BRFSS, 36% of all respondents, 38% of West County, and 31% of East County had been told by a health professional that they had high cholesterol. Adult Asthma: Survey respondents were asked if a doctor had ever told them that they had asthma and if they still have asthma (referred to as current asthma prevalence). According to the results, 12% had been told by a doctor, nurse, or health professional that they had asthma, and 6% of adults currently have asthma. The Texas BRFSS from 2004 reveals that 13% of the population had been told they had asthma, and 7% currently have asthma. There were no significant differences between the East and West County samples in the number of respondents reporting asthma. Risk Factors

The 2004 Williamson County BRFSS asked questions about four factors that can contribute to poor health: body mass index, physical activity, nutrition, and tobacco use. Body Mass Index: 2 Body Mass Index (BMI) is a tool used to indicate weight status in adults, measured by weight and height. The BMI ranges are based on the effect body weight has on disease and death. BMI classifications are underweight (<18.5), normal (18.5 - 24.9), overweight (25.0 - 29.9), and obese (≥ 30.0). The HP 2010 goal is that at least 60% of adults have normal weights (BMI 18.5 - 24.9) and no more than 15% of adults are obese (BMI ≥ 30.0). In the 2004 Williamson County BRFSS 31% of respondents had normal weights; 37% were overweight; and an additional 26% were obese. The Texas BRFSS obesity rate for 2004 is also 26%. The percentage of individuals who are overweight is slightly higher in the East County than in the West County, 38% and 36% respectively.

Body Mass Index

Category HP 2010 Target

Texas BRFSS 2004

WC BRFSS 2004 East WC West WC

Normal (18.5 - 24.9) 60% 35% 31% 31% 31%

Overweight (25.0 - 29.9) 25% 37% 37% 38% 36%

Obese (≥ 30.0) 15% 26% 26% 26% 26%

HP 2010= Healthy People 2010, WC= Williamson County Source: Williamson County BRFSS Survey 2004, the Texas Behavioral Risk Factor Surveillance System 2004, and U.S. Department of Health and Human Services, Healthy People 2010.

Physical Activity: The Healthy People 2010 goals include physical activity targets for adults. The goals include reducing the proportion of adults who engage in no leisure-time physical activity to 20%, increasing the proportion of adults who engage regularly in moderate physical activity for at least 30 minutes per day to 50%, and increasing the proportion of adults who engage in vigorous physical activity 3 or more days per week for 20 or more minutes per occasion to 30%. In the Williamson County 2004 BRFSS, 9% of respondents engaged in no leisure-time physical activity. However, the majority did report physical activity; 53% did meet the HP2010 recommendations for

2 Body Mass Index information and calculators available at http://www.cdc.gov/nccdphp/dnpa/bmi/index.htm


frequency or duration of physical activity while 38% reported some physical activity but not enough to meet recommendations. Over half of the East County (52%) and West County (54%) samples met recommendations for physical activity. The Texas 2004 BRFSS results show that 44% met recommendations for physical activity.

Physical Activity

Category HP 2010 Target

Texas BRFSS

2004 WC BRFSS

2004 East WC West WC

Meets Recommendations* 80% 44% 53% 52% 54%

Does not meet recommendations** 20% 56% 47% 48% 46%

HP 2010= Healthy People 2010, WC= Williamson County

* Meets recommendations = Meets goal of regular moderate physical activity for at least 30 minutes per day and/or vigorous physical activity 3 or more days per week for 20 or more minutes per occasion.

** Does Not Meet Recommendations = No physical activity and/or some physical activity.

Source: Williamson County BRFSS Survey 2004, the Texas Behavioral Risk Factor Surveillance System 2004, and U.S. Department of Health and Human Services, Healthy People 2010.

Respondents to the BRFSS were also asked how much time they spent watching TV or videos or using a computer outside of work each day. Of the total sample, 28% spent 3 to 4 hours and 18% spent 5 or more hours watching TV or using the computer outside of work. Similar results were found for the East and West samples. Nutrition: The Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) publish Dietary Guidelines for Americans3 every 5 years. The Guidelines provide advice about how good dietary habits can promote health and reduce risk for major chronic diseases. In the United States, persons of all ages eat fewer than the recommended number of servings of grain products, vegetables, and fruits. 4 The Guidelines, last published in January 2005, recommend that Americans choose a variety of fruits and vegetables each day, selecting from all 5 vegetable subgroups in particular (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week. HP 2010 targets include increasing the proportion of persons 2 years of age and older who consume at least two daily servings of fruit to 75% and increasing the proportion of persons 2 years of age and older who consume at least 3 daily servings of vegetables to 50%. The BRFSS results indicate that 22% of Williamson County respondents reported consumption of 5 or more fruits or vegetables per day. Percentages were the same for the East County and West County samples. Texas 2003 BRFSS results were similar to Williamson County with 23% of Texans meeting recommendations for fruit and vegetable consumption. Tobacco Use: The HP 2010 target is that not more than 12% of adults smoke cigarettes. The 2004 BRFSS results show that 18% of the sample smoked cigarettes. Smoking rates in the East and West County were similar to the county as a whole. The Texas 2004 BRFSS results show that 20% of respondents smoked. Of current smokers in the East County, 68% had tried to stop smoking for one day or longer in the past 12 months compared with 50% in the West County. Three percent of respondents currently use chewing tobacco or snuff everyday or some days, considerably higher than the national 2010 target of not more than 0.4% of adults. The East County sample (8%) was

3 Dietary Guidelines for Americans 2005, http://www.healthierus.gov/dietaryguidelines/ 4 Crane, NT; Hubbard, VS; and Lewis, CJ National nutrition objectives and the Dietary Guidelines for Americans. Nutrition Today 33:49-58, 1998


more likely than the West County sample (2%) to regularly use chewing tobacco or snuff. This difference is statistically significant. Health Care Access

The 2004 Williamson County BRFSS asked questions about three aspects of health care access: health insurance and use of medical services, dental care, and adult immunizations.

Health Insurance and Use of Medical Services: Of the Williamson County 2004 BRFSS respondents, 84% said that they have some type of health care coverage. This is lower than the rate of 89.2% found in the 1999 BRFSS but higher than the Texas BRFSS 2004 rate of 73%. The HP 2010 target is 100%. For the Williamson County 2004 BRFSS, 80% of respondents had one or more persons they considered to be their personal health care provider. The HP 2010 national target is 85%. Twelve percent of respondents said that there was a time in the last year when they needed to see a doctor but could not because of the cost. Although not statistically significant, this figure is higher for respondents in the East County (15%) than in the West County (11%). Dental Care: The Williamson County 2004 BRFSS asked respondents how long it had been since they had last visited a dentist or dental clinic: 68% within the last year; 10% not in over 5 years (or never). There was a statistically significant difference between East County and West County samples for those who visited dentist or dental clinic in the last year (West 71%, East 59%). Fifty-nine percent of the Texas 2004 BRFSS respondents had visited a dentist or dental clinic in the last year. Adult Immunizations: Of respondents aged 65 years or older, 76% reported receiving a flu shot during the 2003-2004 flu season. This exceeds the Texas BRFSS 2004 rate of 67% but is short of the HP 2010 target of 90% flu shot coverage among those age 65 years or older. Fewer than 30% of all Williamson County respondents age 65 years or older in 1999 reported receiving a flu shot in the previous year.5 Environment

The 2004 Williamson County BRFSS included questions about two aspects of environment and health: attitudes towards health and the built environment6 and public health emergency. Built Environment: Respondents to the Williamson County 2004 BRFSS were asked what their perceptions were about the neighborhood and/or community in which they live. 7 Of the total sample, 62% said that their neighborhood is a “very pleasant” place to walk, and 80% feel that people in their neighborhood are very or somewhat physically active. There was a greater amount of respondents from the West County sample (83%) who perceived their neighborhood as physically active compared to the East County sample (67%). Of the total sample, 33% said that they felt “extremely safe” from crime in their neighborhood, which is somewhat lower than the 38% who reported the same in 1999. Of the East County sample, 17% said they felt “slightly safe” from crime in their neighborhood while 9% did in West County. This difference is statistically significant.

5 The Williamson County 2004 BRFSS survey addressed the 2003-2004 flu season, not the most recent 2004-2005 flu season that had well publicized problems with flu vaccine production. 6 Built environment is the urban environment consisting of buildings, roads, fixtures, parks, and all other improvements that form the physical character of a city or community. 7 For the purpose of the BRFSS survey, neighborhood is defined as the area within one-half mile or a ten minute walk from an interviewee’s house and community is defined as a 5 mile or 10 mile drive from an interviewee’s house.


When asked if their neighborhood had any sidewalks, 62% of all respondents said they did. Statistically significant disparities were found among East County and West County respondents for sidewalks; 26% of respondents in the East County said they have sidewalks in their neighborhood compared with 70% in the West County. The rural nature of the East County could have influenced this result. When asked if respondents use walking trails, parks, playgrounds, and sports fields in their community for physical activity, 53% said that they did use those types of facilities. East County respondents are statistically less likely to use such facilities; 62% of East County and 39% of West County respondents said they did not use walking trails, parks, playgrounds, and sports fields in their community. Seven percent of East County respondents said that no such facilities are available in their community while only 2% of West County respondents did. Public Health Emergency: Williamson County 2004 BRFSS respondents were asked several questions about what would happen if there were a health emergency or natural disaster in Williamson County. For all respondents, 68% said they have a radio that will work without regular electricity. While 86% have a 3-day supply of food, only 50% have a 3-day supply of water. Sixty percent of East County respondents and 47% of West County respondents had a 3-day supply of water; this difference is statistically significant. In an open-ended question respondents were asked “If you believed that you were exposed to a new or dangerous disease, and you wanted more information, where would you go first to get that information?” Of all respondents, 39% said they would seek information from the Internet, 24% would seek information from their doctor, 11% would get information from a hospital, and 10% would go to the local health department (Williamson County). When asked if their doctor requested they get a vaccination to prevent a new dangerous disease, 93% of all respondents said they would agree to get a vaccination and stay home if advised to in order to avoid spreading the disease. There were no differences in the results for the same questions for the East County and West County samples.


Conclusions In general, outcomes of the 2004 Williamson County BRFSS show that as a whole Williamson County fares better than the State of Texas on many measures of health. It is reasonable to conclude that this outcome is influenced by its favorable demographics, including a relatively young population and higher average levels of education and income than the State of Texas. Williamson County measures for chronic disease prevalence are very near the statewide figures, but both Williamson County and Texas fall short of the Healthy People 2010 targets for disease prevalence. For preventive care measures such as cholesterol check, flu shots, and dental visits, Williamson County measures are better than statewide figures but again below Healthy People 2010 targets. Williamson County also fares better than the state on overall health status, health insurance coverage, physical activity, and exercise but is below the Healthy People 2010 target for health insurance coverage.

Comparison of Texas, Williamson County, and Healthy People 2010

Category WC BRFSS 2004

Texas BRFSS HP 2010

Diabetes 8% 8%* 2.5%

High Blood Pressure 22% 24%* 16%

Cholesterol Check within past 5yrs 78% 68%* 80%

High Cholesterol 36% 34%* 17%

Adult Asthma 6% 7% n/a

Current Smoker 18% 20% 12%

Smokeless Tobacco 3% n/a n/a

Flu Shot, Over 65(1) 76% 68% 90%

Obese(2) 26% 26% 15%

Overweight 37% 37% 25%

Physical Activity 53% 44% 80%(3)

Nutrition 22% 23% 50-75(4)

Overall Health Fair or Poor 11% 20% n/a

Health Insurance 84% 73% 100%

Primary Provider 80% n/a 85%

Dental Visit within past year 68% 59% n/a * The Texas BRFSS data in this table are from the year 2004 except for those noted with an asterisk (*), which are from the survey year 2003.

(1) The Williamson County 2004 BRFSS survey addressed the 2003-2004 flu season, not the most recent 2004-2005 flu season that had well publicized problems with flu vaccine production.

(2) Obese and overweight are mutually exclusive. (3) Combined value of Healthy People 2010 targets for objectives 22-2 and 22-3 (See Appendix C). (4) Healthy People 2010 recommend 50% over the age of 2 consume 3 daily servings of vegetables and 75% consume at least

2 daily servings of fruit. (See objectives 19-5 and 19-6 in Appendix C).

n/a – Not available

Source: Williamson County BRFSS Survey 2004, the Texas Behavioral Risk Factor Surveillance System 2003, 2004, and Healthy People 2010: Understanding and Improving Health and Objectives for Improving Health. 2nd ed.


Chronic disease prevalence and behavioral risk factors such as those measured in the 1999 and 2004 Williamson County BRFSS vary by indicators that are identified with social advantage, such as educational attainment, occupational class, and income level. Populations that are older, poorer, and have lower levels of education and income tend to have higher chronic disease prevalence and greater behavioral risks. According to the US Department of Health and Human Services, there are continuing disparities in the burden of illness and death experienced by African Americans, Hispanic Americans, Asian Americans/Pacific Islanders, and American Indians/Alaska Natives, as compared to the U.S. population as a whole. Where the 1999 and 2004 surveys are comparable, differences in chronic disease prevalence and behavioral risks between the surveys have generally been very small. There appear to have been increases in the prevalence of diabetes and in the proportion of the adult population above normal weight, both of which are consistent with national trends over the same time period. Likewise, a decline in the proportion of the adult population covered by some kind of health insurance is consistent with the national trend. Note: Tests of statistical significance have not been run between the Williamson County 2004 and 1999 data, and differences may be due to sampling error.

Comparison of Williamson County BRFSS 1999 and 2004

Category WC BRFSS 1999 WC BRFSS 2004

Diabetes 5% 8% High Blood Pressure 21% 22% Cholesterol Check within past 5yrs 77% 78% High Cholesterol 35% 36% Adult Asthma n/a 6% Current Smoker 18% 18% Smokeless Tobacco 3.5% 3% Flu Shot, Over 65(1) 63% 76% Obese(2) 21% 26% Overweight 34% 37% Physical Activity 44% 53% Nutrition 14% 22% Overall Health Fair or Poor 11% 11% Health Insurance 89% 84% Primary Provider n/a 80% Dental Visit within past year n/a 68%

(1) The Williamson County 2004 BRFSS survey addressed the 2003-2004 flu season, not the most recent 2004-2005 flu

season that had well publicized problems with flu vaccine production. (2) Obese and overweight are mutually exclusive.

Changes in the questions used to measure diet account for most of the difference between 1999 and 2004.

n/a – Not available

Source: Williamson County BRFSS Survey 2004, Williamson County BRFSS Survey 1999


Differences between the West County and East County samples in the 2004 BRFSS can also largely be explained in terms of demographic differences. The East County population has greater chronic disease prevalence and behavioral risk, and it also has the demographic characteristics that would predict greater risk. The East County population is older, less educated, and earns less income. The East also has more African Americans and Hispanics. As noted above, there are continuing disparities in the burden of illness and death experienced by these racial/ethnic populations. In addition, because the eastern portion of the county is rural and less densely populated, there are fewer medical services; therefore, residents in eastern Williamson County have to travel farther to access medical care, especially specialty care. The East County sample's results on the 2004 BRFSS mirror very closely the statewide results; most of the county's "advantage" is related to the more populous West portion of the county. Compared to the East County sample, the West County sample has a lower prevalence of diabetes, high blood pressure, and adult asthma. However, the East County sample has a lower prevalence of high cholesterol. The East County sample experiences poorer overall health and has more difficulty gaining access to medical and dental care. The built environment in the eastern section of the county is less conducive to use for recreation and physical activity.

Comparison of East County and West County Samples

Factor East County

Sample West County

Sample Diabetes 10% 7% High Blood Pressure 29% 21% High Cholesterol 31% 38% Adult Asthma 7% 6% Current Smoker 19% 18% → Smokeless Tobacco 8% 2% Flu Shot, Over 65(1) 75% 76% Obese(2) 26% 25% Overweight 38% 36% Physical Activity 52% 54% Nutrition 22% 22% → General Health Fair or Poor 18% 10% → Physical Health “not good” 5+ days 18% 11% No Health Insurance 17% 15% No Primary Provider 22% 20% No Doctor due to Cost 15% 11% No Dental Visit in 5+ yrs. 13% 8% → Neighborhood Slightly Safe 17% 9% → No Sidewalks 74% 30% → Private Recreation Facility Use 11% 32% → Walking Trails and Park use 32% 58% → Public Recreation Center Use 17% 28%

→ Indicates a difference that is statistically significant at a 95% confidence interval.

(1) The Williamson County 2004 BRFSS survey addressed the 2003-2004 flu season, not the most recent 2004-2005 flu season that had well publicized problems with flu vaccine production.

(2) Obese and overweight are mutually exclusive.

Source: Williamson County BRFSS Survey 2004


What do these findings mean for public health planning and the future health of the people of Williamson County? While Williamson County’s levels of chronic disease prevalence and behavioral risk are generally favorable compared to the State of Texas, the county does contain chronically ill and at-risk residents who often have difficulty accessing medical care. Williamson County residents, communities, health care providers, and public health advocates must not be complacent or adopt a false sense of security. Despite its demographic advantages, Williamson County falls short of almost all Healthy People 2010 objectives. Designed to increase quality and years of healthy life and to eliminate health disparities, the Healthy People 2010 target measures should motivate Williamson County to put into practice a systematic approach to monitor health of residents and to focus on expanding achievements in health. Williamson County must strive in supporting the health of residents by encouraging positive lifestyle choices and promoting healthy physical and social environments and the policies and interventions used to promote health, prevent disease, and ensure access to quality health care.

Section II

Tables and Graphs for Common Health Indicators & Risk Factors

Williamson County 2004 BRFSSSection II, Page 1

Williamson County – DiabetesAdults Ages 18 Years and Over

Behavioral Risk Factor Surveillance System, 2004

Doctor diagnosed diabetes:

8%

92%

10%

90%

7%

93%

0%

20%

40%

60%

80%

100%

County East West

Doctor Diagnosed Diabetes

Yes

No


(90-95)93(87-93)90(90-94)92No

(5-10)7(7-13)10(6-10)8Yes

95% CIPercent (%)95% CIPercent

(%)95% CIPercent (%)

WestEastCounty



Williamson County – High Blood PressureAdults Ages 18 Years and Over


Diagnosed with High Blood Pressure:

22%

78%

29%

71%

21%

79%

0%

20%

40%

60%

80%

100%

County East West

Diagnosed with High Blood Pressure

Yes

No


(75-83)79(66-75)71(74-81)78No

(17-25)21(25-34)29(19-26)22Yes



WestEastCounty



Williamson County – High Blood PressureAdults Ages 18 Years and Over


Taking Medication to Control High Blood Pressure :

73%

27%

82%

18%

70%

30%

0%

20%

40%

60%

80%

100%

County East West

Taking Medication to Control High Blood Pressure

Yes

No


(21-42)30(11-26)18(20-36)27No

(58-79)70(74-89)82(64-80)73Yes



WestEastCounty



Williamson County – CholesterolAdults Ages 18 Years and Over


Cholesterol Checked In Past 5 Years :

78%

22%

74%

26%

79%

21%

0%

20%

40%

60%

80%

100%

County East West

Cholesterol Checked in Past 5 Years

Yes

No


(17-26)21(21-31)26(18-26)22No

(74-83)79(69-79)74(74-82)78Yes



WestEastCounty



Williamson County – CholesterolAdults Ages 18 Years and Over


Diagnosed With High Cholesterol :

36%

64%

31%

69%

38%

62%

0%

20%

40%

60%

80%

100%

County East West

Diagnosed with High Cholesterol

Yes

No


(57-68)62(64-75)69(59-68)64No

(32-43)38(25-36)31(32-41)36Yes



WestEastCounty



Williamson County – Adult AsthmaAdults Ages 18 Years and Over


Current Asthma (Adult):

6%

94%

7%

93%

6%

94%

0%

20%

40%

60%

80%

100%

County East West

Current Asthma (Adult)

Yes

No


(92-96)94(90-96)93(92-96)94No

(4-8)6(4-10)7(4-8)6Yes



WestEastCounty



Williamson County – Tobacco UseAdults Ages 18 Years and Over


Current Smoker:


(78-86)82(76-85)81(78-85)82No

(14-22)18(15-24)19(15-22)18Yes



WestEastCounty

18%

82%

19%

81%

18%

82%

0%

20%

40%

60%

80%

100%

County East West

Current Smoker

Yes

No



Williamson County – Tobacco UseAdults Ages 18 Years and Over


Current Use of Smokeless Tobacco:

97%

3%

92%

8%

98%

2%

0%

20%

40%

60%

80%

100%

County East West

Current Use of Smokeless Tobacco

Not at all

Every day orsome days


(1-4)2(5-11)8(2-5)3Every day or some days

(96-99)98(89-95)92(95-98)97Not at all



WestEastCounty



Williamson County – ImmunizationAdults Ages 18 Years and Over


Flu Shot In Past Year, Age 65+:

76%

24%

75%

25%

76%

24%

0%

20%

40%

60%

80%

100%

County East West

Flu Shot in Past Year, Age 65+

Yes

No


(13-39)24(16-36)25(16-35)24No

(61-87)76(64-84)75(65-84)76Yes



WestEastCounty



Williamson County – Body Mass IndexAdults Ages 18 Years and Over


Obese1 (Body Mass Index ≥ 30.0) :

26% 26% 25%

0%

10%

20%

30%

40%

50%

County East West

Obese (BMI >= 30)


(21-31)25(22-31)26(22-30)26Obese



WestEastCounty

1 Obese and overweight are exclusive





Overweight1 (Body Mass Index 25.0-29.9) :

37% 38% 36%

0%

10%

20%

30%

40%

50%

County East West

Overweight (BMI 25.0-29.9)


(31-42)36(33-43)38(32-41)37Overweight



WestEastCounty


1 Obese and overweight are exclusive


Meets recommendations for moderate or vigorous physical activity:




(41-52)46(43-54)48(42-51)47No

(48-59)54(46-57)52(49-58)53Yes



WestEastCounty

53% 47% 52% 48% 54%46%

0%

20%

40%

60%

80%

100%

County East West

Meets Recommendations for Moderate or Vigorous Physical Activity

Yes

No



Meets recommendations for fruits and vegetables:



22%

78%

22%

78%

22%

78%

0%

20%

40%

60%

80%

100%

County East West

Meets Recommendations for Fruits and Vegetables

Yes

No



(74-83)78(73-82)78(74-82)78No

(17-26)22(18-27)22(18-26)22Yes



WestEastCounty

Section III

Data Tables

Williamson County Adults Ages 18 Years and Over


Williamson County BRFSS 2004 Section III, Page 1

HEALTH STATUS Would you say that in general your health is excellent, very good, good, fair, or poor?

95% CI

Area Sample Size Factor % Lower Upper

Total 827 Health is fair or poor 11 9 14 Health is good, very good, or excellent 89 85 91

East 417 Health is fair or poor 18 14 22 Health is good, very good, or excellent 82 78 86

West 410 Health is fair or poor 10 7 13 Health is good, very good, or excellent 90 87 93

HEALTH DAYS Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?

95% CI


Total 810 No days or less than 5 days 88 85 90 5 or more days 12 10 15

East 403 No days or less than 5 days 82 77 86 5 or more days 18 14 23

West 407 No days or less than 5 days 89 86 92 5 or more days 11 8 14

Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?

95% CI








During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

95% CI





HEALTH CARE ACCESS Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?

95% CI


Total 826 Yes 84 80 88 No 16 12 20

East 417 Yes 83 79 87 No 17 13 21

West 409 Yes 85 80 89 No 15 11 20

Do you have one person you think of as your personal doctor or health care provider?

95% CI


Total 824 Yes, only one 73 69 77 More than one 7 5 9 No 20 17 24

East 415 Yes, only one 69 64 74 More than one 9 6 11 No 22 18 27

West 409 Yes, only one 74 69 79 More than one 6 4 9 No 20 16 24




Was there a time in the past 12 months when you needed to see a doctor but could not because of the cost?

95% CI


Total 822 Yes 12 9 15 No 88 85 91

East 413 Yes 15 12 19 No 85 81 88

West 409 Yes 11 8 15 No 89 85 92




TOBACCO USE Current Smokers

95% CI


Total 825 Not at risk 82 78 85 At risk 18 15 22

East 417 Not at risk 81 76 85 At risk 19 15 24

West 408 Not at risk 82 78 86 At risk 18 14 22

Smoking Status

95% CI


Total 825 Current smoker - every day 13 10 16 Current smoker - some days 5 4 8 Former smoker 22 18 26 Never smoked 60 56 64

East 417 Current smoker - every day 12 9 16 Current smoker - some days 7 5 11 Former smoker 18 14 22 Never smoked 63 57 68

West 408 Current smoker - every day 13 10 17 Current smoker - some days 5 3 8 Former smoker 23 19 28 Never smoked 59 54 65

During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?

95% CI


Total 145 Yes 54 43 64 No 46 36 57

East 75 Yes 68 55 79 No 32 21 45

West 70 Yes 50 38 62 No 50 38 62




OTHER TOBACCO

Have you ever used or tried any smokeless tobacco products such as chewing tobacco or snuff?

95% CI


Total 827 Yes 21 17 25 No 79 75 83

East 417 Yes 24 20 29 No 76 71 80

West 410 Yes 20 16 25 No 80 75 84

Do you currently use chewing tobacco or snuff every day, some days, or not at all?

95% CI


Total 827 Not at all 97 95 98 Every day or some days 3 2 5

East 417 Not at all 93 89 95 Every day or some days 7 5 11

West 410 Not at all 98 95 99 Every day or some days 2 1 5

Current smokeless tobacco users:

95% CI


Total 827 Yes 3 2 5 No 97 95 98

East 417 Yes 8 5 11 No 92 89 95

West 410 Yes 2 1 4 No 98 96 99




DIABETES Have you ever been told by a doctor that you have diabetes?

95% CI


Total 827 Yes 8 6 10 No 92 90 94

East 417 Yes 10 7 13 No 90 87 93

West 410 Yes 7 5 10 No 93 90 95




HIGH BLOOD PRESSURE Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?

95% CI


Total 827 Yes 22 19 26 No 78 74 81

East 417 Yes 29 25 34 No 71 66 75

West 410 Yes 21 17 25 No 79 75 83

Are you currently taking medicine for your high blood pressure?

95% CI


Total 232 Yes 73 64 80 No 27 20 36

East 136 Yes 82 74 89 No 18 11 26

West 96 Yes 70 58 79 No 30 21 42




CHOLESTEROL Have you ever had your blood cholesterol checked?

95% CI


Total 818 Yes 82 78 85 No 18 15 22

East 413 Yes 79 74 83 No 21 17 26

West 405 Yes 82 77 86 No 18 14 23

Cholesterol Checked Within Last 5 Years

95% CI


Total 810 Yes 78 74 82 No 22 18 26

East 409 Yes 74 69 79 No 26 21 31

West 401 Yes 79 74 83 No 21 17 26

Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?

95% CI


Total 678 Yes 36 32 41 No 64 59 68

East 334 Yes 31 25 36 No 69 64 75

West 344 Yes 38 32 44 No 62 57 68




ADULT ASTHMA Have you ever been told by a doctor, nurse, or other health professional that you had asthma?

95% CI


Total 827 Yes 12 9 15 No 88 85 91

East 417 Yes 11 8 15 No 89 85 92

West 410 Yes 12 9 16 No 88 84 91

Do you currently have asthma?

95% CI


Total 826 Yes 6 4 8 No 94 92 96

East 417 Yes 7 4 10 No 93 90 96

West 409 Yes 6 4 8 No 94 92 96

CHILDHOOD ASTHMA Children with Current Asthma

95% CI


Total 346 Current Asthma 8 5 10

East 164 Current Asthma 6 3 9

West 182 Current Asthma 8 5 11




ORAL HEALTH How long has it been since you last visited a dentist or a dental clinic for any reason?

95% CI


Total 823 Within the past year 68 64 72 Within the past 2 years 12 9 15 Within the past 5 years 10 7 12 5 or more years ago 9 7 12 Never 1 1 2

East 414 Within the past year 59 53 64 Within the past 2 years 14 11 19 Within the past 5 years 12 9 16 5 or more years ago 13 9 17 Never 3 1 6

West 409 Within the past year 71 66 75 Within the past 2 years 11 8 15 Within the past 5 years 9 7 13 5 or more years ago 8 5 12 Never 1 1 3




IMMUNIZATION During the past 12 months, have you had a flu shot?

95% CI


Total 827 Yes 38 33 42 No 62 58 67

East 417 Yes 39 34 44 No 62 56 66

West 410 Yes 37 32 43 No 63 57 68

Flu shot within the past year, Ages 65 years and older:

95% CI


Total 130 Yes 76 65 84 No 24 16 35

East 81 Yes 75 64 84 No 25 16 36

West 49 Yes 76 61 87 No 24 13 39

During the past 12 months, have you had a flu vaccine that was sprayed in your nose?

95% CI


Total 827 Yes 2 1 3 No 98 97 99

East 417 Yes 1 1 3 No 99 97 99

West 410 Yes 2 1 4 No 98 96 99




FRUITS AND VEGETABLES Fruit and Vegetable Serving Index

95% CI


Total 827 Less than 1 time per day or never 5 4 8 1 to less than 3 times per day 37 33 42 3 to less than 5 times per day 36 32 40 5 or more times per day 22 18 26

East 417 Less than 1 time per day or never 5 3 9 1 to less than 3 times per day 39 34 44 3 to less than 5 times per day 34 29 39 5 or more times per day 22 18 29

West 410 Less than 1 time per day or never 5 3 8 1 to less than 3 times per day 37 32 42 3 to less than 5 times per day 36 31 42 5 or more times per day 22 17 26

Five Fruits and Vegetables A Day

95% CI


Total 827 Less than 5 78 74 82 5 or more 22 18 26

East 417 Less than 5 78 73 82 5 or more 22 18 27

West 410 Less than 5 78 74 83 5 or more 22 17 26




DEMOGRAPHICS Age Groups (Years)

95% CI


Total 814 18 to 44 62 58 66 45 to 64 28 24 31 65+ 11 9 13

East 412 18 to 44 54 49 59 45 to 64 29 25 34 65+ 17 14 21

West 402 18 to 44 64 58 69 45 to 64 27 23 32 65+ 9 7 12

95% CI


Total 814 18 to 24 10 7 14 25 to 34 25 21 29 35 to 44 27 23 31 45 to 54 16 13 19 55 to 64 12 9 15 65+ 11 9 13

East 412 18 to 24 8 5 12 25 to 34 23 19 29 35 to 44 23 18 28 45 to 54 16 13 20 55 to 64 13 10 16 65+ 17 14 21

West 402 18 to 24 11 7 16 25 to 34 26 21 31

35 to 44 27 23 33 45 to 54 16 12 20 55 to 64 12 9 15 65+ 9 7 12




Hispanic or Latino?

95% CI


Total 826 Yes 16 12 19 No 84 81 88

East 417 Yes 23 18 28 No 77 72 82

West 409 Yes 14 10 18 No 86 82 90

Race

95% CI


Total 815 White 84 80 87 Black or African American 4 3 6 Asian 2 1 3 Native Hawaiian or Other Pacific Islander 0 0 3 American Indian, Alaskan Native 1 0 2 Other 9 7 12

East 410 White 76 71 80 Black or African American 8 6 12 Asian 1 0 2 Native Hawaiian or Other Pacific Islander 0 0 0 American Indian, Alaskan Native 1 0 4 Other 14 11 19

West 405 White 86 81 89 Black or African American 3 2 5

Asian 2 1 4 Native Hawaiian or Other Pacific Islander 0 0 3 American Indian, Alaskan Native 1 0 2 Other 8 5 12




Race/Ethnicity

95% CI


Total 824 White 76 72 80 Black 4 3 6 Hispanic 16 12 19 Other 5 3 7

East 415 White 66 61 71 Black 8 6 12 Hispanic 23 18 28 Other 3 2 5

West 409 White 78 73 83 Black 3 2 5

Hispanic 14 10 18 Other 5 3 8

Marital Status

95% CI


Total 824 Married 69 65 73 Divorced 8 6 10 Widowed 3 2 4 Separated 1 1 3 Never Married 15 11 19 A member of an unmarried couple 4 2 6

East 416 Married 70 65 74 Divorced 7 5 10 Widowed 6 4 8 Separated 2 1 4 Never Married 12 8 16 A member of an unmarried couple 3 2 6

West 408 Married 69 64 74 Divorced 8 6 11

Widowed 3 2 4 Separated 1 1 3 Never Married 15 11 20 A member of an unmarried couple 4 2 7




Marital Status, Condensed

95% CI


Total 824 Married 69 65 73 Unmarried 31 27 35

East 416 Married 70 65 74 Unmarried 30 26 35

West 408 Married 69 64 74 Unmarried 31 26 36

Gender

95% CI


Total 827 Male 49 45 54 Female 51 46 55

East 417 Male 50 45 56 Female 50 44 55

West 410 Male 49 43 54 Female 51 46 57

Children less than 18 years of age live in household

95% CI


Total 826 None 50 46 55 1 22 18 26 2 16 13 20 3 or more 11 9 15

East 417 None 51 46 57 1 17 14 22 2 18 14 23 3 or more 13 10 17

West 409 None 50 44 55 1 23 19 28 2 16 13 20 3 or more 11 8 15




Highest grade or year in school completed

95% CI


Total 824 Never attended or only attended kindergarten 0 0 2 Grades 1 through 8 (Elementary) 2 1 4 Grades 9 through 11 (Some high school) 5 4 7 Grade 12 or GED (High school graduate) 27 23 31

College 1 year to 3 years (Some college or technical school) 25 22 29

College 4 years or more (College graduate) 40 36 44

East 415 Never attended or only attended kindergarten 0 0 1 Grades 1 through 8 (Elementary) 6 4 9 Grades 9 through 11 (Some high school) 12 9 16 Grade 12 or GED (High school graduate) 35 30 41


College 4 years or more (College graduate) 20 16 25

West 409 Never attended or only attended kindergarten 0 0 3 Grades 1 through 8 (Elementary) 1 0 4 Grades 9 through 11 (Some high school) 3 2 6 Grade 12 or GED (High school graduate) 25 21 30


College 4 years or more (College graduate) 45 40 50 Education Categories

95% CI


Total 824 Less than high school 8 6 10 High school graduate 27 23 31 Some college 25 22 29 College graduate 40 36 44

East 415 Less than high school 18 14 22 High school graduate 35 30 41 Some college 27 22 32 College graduate 20 16 25

West 409 Less than high school 4 3 8 High school graduate 25 21 30 Some college 25 21 30 College graduate 45 40 50




Employment Status, All Ages

95% CI


Total 827 Employed for wages 56 51 60 Self-employed 10 8 13 Out of work for more than 1 year 2 1 4 Out of work for less than 1 year 4 3 6 Homemaker 9 7 12 Student 4 2 6 Retired 12 10 15 Unable to work 2 1 4

East 417 Employed for wages 56 51 62 Self-employed 10 7 13 Out of work for more than 1 year 3 2 6 Out of work for less than 1 year 4 2 7 Homemaker 9 7 13 Student 1 0 2 Retired 14 11 17 Unable to work 4 2 6

West 410 Employed for wages 56 50 61 Self-employed 10 8 14 Out of work for more than 1 year 2 1 5 Out of work for less than 1 year 5 3 8 Homemaker 9 7 13 Student 4 2 8 Retired 12 9 15 Unable to work 2 1 4

Employment Status, All Ages, Condensed

95% CI


Total 827 Employed 66 62 70 Not Employed 34 30 38

East 417

Employed 66 61 71 Not Employed 34 29 39

West 410 Employed 66 61 71 Not Employed 34 29 39




Employment Status, Ages Less Than 65 Years

95% CI


Total 535 Employed 85 82 89 Not Employed 15 12 18

East 274 Employed 80 75 85 Not Employed 20 15 25

West 261 Employed 87 82 90 Not Employed 13 10 18

Annual Household Income

95% CI


Total 730 Less than $10,000 2 1 4 $10,000 to less than $15,000 3 2 4 $15,000 to less than $20,000 6 4 8 $20,000 to less than $25,000 9 6 12 $25,000 to less than $35,000 8 6 11 $35,000 to less than $50,000 14 12 18 $50,000 to less than $75,000 22 19 26 $75,000+ 36 31 41

East 366 Less than $10,000 3 2 6 $10,000 to less than $15,000 6 4 10 $15,000 to less than $20,000 10 7 14 $20,000 to less than $25,000 10 7 14 $25,000 to less than $35,000 11 8 15 $35,000 to less than $50,000 18 14 23 $50,000 to less than $75,000 25 20 30 $75,000+ 17 13 22

West 364 Less than $10,000 2 1 4 $10,000 to less than $15,000 2 1 4 $15,000 to less than $20,000 5 3 7 $20,000 to less than $25,000 8 5 13 $25,000 to less than $35,000 8 5 11 $35,000 to less than $50,000 14 10 18 $50,000 to less than $75,000 22 18 27 $75,000+ 40 35 46





95% CI


Total 730 Less than $15,000 5 4 7 $15,000 to less than $25,000 14 11 18 $25,000 to less than $35,000 8 6 11 $35,000 to less than $50,000 14 12 18 $50,000+ 58 53 63

East 366 Less than $15,000 10 7 14 $15,000 to less than $25,000 20 16 25 $25,000 to less than $35,000 11 8 15 $35,000 to less than $50,000 18 14 23 $50,000+ 42 36 47

West 364 Less than $15,000 4 2 6 $15,000 to less than $25,000 13 9 18 $25,000 to less than $35,000 8 5 11 $35,000 to less than $50,000 14 10 18 $50,000+ 62 56 67


95% CI


Total 730 Less than $25,000 19 16 23 $25,000 to less than $75,000 45 40 50 $75,000+ 36 31 41

East 366 Less than $25,000 30 25 35

$25,000 to less than $75,000 54 48 59 $75,000+ 17 13 22

West 364 Less than $25,000 17 13 22

$25,000 to less than $75,000 43 38 49 $75,000+ 40 35 46




OVERWEIGHT AND OBESITY BMI Categories

95% CI


Total 782 Not overweight or obese (BMI < 25.0) 38 33 42 Overweight (BMI 25.0 - 29.9) 37 32 41 Obese (BMI ≥ 30.0) 26 22 30

East 397 Not overweight or obese (BMI < 25.0) 36 31 41 Overweight (BMI 25.0 - 29.9) 38 33 43 Obese (BMI ≥ 30.0) 26 22 31

West 385 Not overweight or obese (BMI < 25.0) 38 33 44

Overweight (BMI 25.0 - 29.9) 36 31 42 Obesity (BMI ≥ 30.0) 26 21 31

BMI Categories

95% CI


Total 782 Underweight (BMI < 18.5) 7 4 10 Not overweight or obese (BMI ≥ 18.5 and BMI < 25.0) 31 27 36 Overweight (BMI 25.0 - 29.9) 37 32 41 Obese (BMI ≥ 30.0) 17 14 21 Morbidly Obese (BMI ≥ 35.0) 8 6 11

East 397 Underweight (BMI < 18.5) 4 3 8 Not overweight or obese (BMI ≥ 18.5 and BMI < 25.0) 31 27 37 Overweight (BMI 25.0 - 29.9) 38 33 43 Obese (BMI ≥ 30.0) 14 11 18 Morbidly Obese (BMI ≥ 35.0) 12 9 16

West 385 Underweight (BMI < 18.5) 7 4 11 Not overweight or obese (BMI ≥ 18.5 and BMI < 25.0) 31 26 36 Overweight (BMI 25.0 - 29.9) 36 31 42 Obese (BMI ≥ 30.0) 18 14 23 Morbidly Obese (BMI ≥ 35.0) 7 5 11




PHYSICAL ACTIVITY When you are at work, which of the following best describes what you do?

95% CI


Total 526 Mostly sitting or standing 67 62 72 Mostly walking 21 17 25 Mostly heavy labor/ physically demanding work 12 9 16

East 261 Mostly sitting or standing 60 53 67 Mostly walking 25 19 31 Mostly heavy labor / physically demanding work 15 11 21

West 265 Mostly sitting or standing 69 63 75 Mostly walking 20 15 25 Mostly heavy labor / physically demanding work 11 7 16


95% CI


Total 805 Meets recommendations 53 49 58

Some physical activity, but does not meet recommendations 38 33 42

No physical activity 9 7 12

East 401 Meets recommendations 52 46 57



West 404 Meets recommendations 54 48 59







95% CI


Total 810 Yes 53 49 58 No 47 42 51

East 405 Yes 52 46 57 No 48 43 54

West 405 Yes 54 48 59 No 46 41 52

TV VIEWING Over the past 30 days, on a typical day, how much time did you spend sitting and watching TV or videos or using a computer outside of work?

95% CI


Total 819 Less than 1 hour 8 6 11 1 hour 17 14 20 2 hours 29 26 34 3 hours 19 15 22 4 hours 9 7 12 5 hours or more 18 15 22

You do not watch TV or videos or use a computer outside of work 0 0 1

East 412 Less than 1 hour 10 7 13

1 hour 18 14 23 2 hours 27 22 32 3 hours 16 13 21 4 hours 10 7 13 5 hours or more 18 14 23


West 407 Less than 1 hour 8 5 11

1 hour 16 13 21 2 hours 30 25 35 3 hours 19 15 24 4 hours 9 6 12 5 hours or more 18 14 23





NEIGHBORHOOD (BUILT ENVIRONMENT) In general, would you say that the people in your neighborhood are…

95% CI


Total 757 Very physically active 14 11 18 Somewhat physically active 66 61 70 Not very physically active 16 13 20 Not at all very physically active 3 2 5

East 376 Very physically active 12 9 17 Somewhat physically active 55 49 61 Not very physically active 26 21 31 Not at all very physically active 7 4 11

West 381 Very physically active 15 11 19 Somewhat physically active 68 63 73 Not very physically active 14 11 18 Not at all very physically active 3 1 5

Overall, how would you rate your neighborhood as a place to walk? Would you say...

95% CI


Total 823 Very pleasant 62 58 66 Somewhat pleasant 30 27 35 Not very pleasant 5 4 7 Not at all pleasant 2 1 4

East 413 Very pleasant 55 50 60 Somewhat pleasant 35 30 41 Not very pleasant 7 5 10 Not at all pleasant 2 1 5

West 410 Very pleasant 64 59 69 Somewhat pleasant 29 25 34 Not very pleasant 5 3 7 Not at all pleasant 2 1 4




How safe from crime do you consider your neighborhood to be? 95% CI


Total 818 Extremely safe 33 29 37 Quite safe 55 51 60 Slightly safe 10 8 13 Not at all safe 2 1 4

East 410 Extremely safe 31 26 36 Quite safe 49 44 55 Slightly safe 17 13 22 Not at all safe 3 1 5

West 408 Extremely safe 33 28 38 Quite safe 57 51 62 Slightly safe 9 6 12 Not at all safe 2 1 4

Does your neighborhood have any sidewalks?

95% CI


Total 825 Yes 62 58 66 No 38 34 42

East 417 Yes 26 21 30 No 74 70 79

West 408 Yes 70 65 75 No 30 25 35

Do you use any private or membership only recreation facilities in your community for physical activity?

95% CI


Total 823 Yes 28 24 32 No 68 64 72 My community does not have these facilities 4 2 6

East 416 Yes 11 8 15 No 84 80 88 My community does not have these facilities 5 3 7

West 407 Yes 32 27 37 No 64 59 69 My community does not have these facilities 4 2 7




Do you use walking trails, parks, playgrounds, sports fields in your community for physical activity?

95% CI


Total 826 Yes 53 48 57 No 43 39 48 My community does not have these facilities 4 3 6



Do you use any public recreation centers in your community for physical activity?

95% CI


Total 825 Yes 26 22 30 No 71 66 75

My community does not have these facilities 3 2 5



Do you use schools that are open in your community for public recreation activities?

95% CI


Total 818 Yes 18 15 22 No 80 76 84 Schools in my community are not open for the public to use 2 1 4

East 413 Yes 16 13 20 No 81 76 85 Schools in my community are not open for the public to use 3 2 6

West 405 Yes 18 14 23

No 80 75 84 Schools in my community are not open for the public to use 2 1 4




PUBLIC HEALTH EMERGENCY Does your household have a radio that would work if the power went out?

95% CI


Total 821 Yes 68 64 72 No 32 28 36

East 415 Yes 63 58 68 No 37 32 42

West 406 Yes 69 64 74 No 31 26 36

Does your household have a 3 day supply of food for everyone who lives there?

95% CI


Total 824 Yes 86 83 89 No 14 11 17

East 417 Yes 84 80 88 No 16 12 20

West 407 Yes 87 83 90 No 13 10 17

Does your household have a 3 day supply of water for everyone who lives there?

95% CI


Total 822 Yes 50 45 54 No 50 46 55

East 417 Yes 60 55 65 No 40 35 45

West 405 Yes 47 42 53 No 53 48 58




If you believed that you were exposed to a new or dangerous disease, and you wanted more information, where would you go first to get that information?

95% CI


Total 769 Your doctor's office 24 20 28 A hospital or emergency room 11 8 14 The local health department (Williamson County) 10 8 14 A relative or friend 0 0 1 Call 911 3 2 5 The Texas Department of Health 3 2 5 The internet 39 35 44 TV or radio 2 1 4 Pharmacist 0 0 0 Other 6 5 9

East 385 Your doctor's office 24 20 29 A hospital or emergency room 16 12 20 The local health department (Williamson County) 11 8 15 A relative or friend 1 0 3 Call 911 6 4 9 The Texas Department of Health 6 4 9 The internet 26 21 31 TV or radio 1 0 3 Pharmacist 0 0 1 Other 9 6 12

West 384 Your doctor's office 24 20 29 A hospital or emergency room 10 7 14 The local health department (Williamson County) 10 7 14 A relative or friend 0 0 2 Call 911 2 1 5 The Texas Department of Health 3 2 5 The internet 42 37 48 TV or radio 3 1 5 Pharmacist 0 0 0 Other 6 4 9




If my doctor or health care provider advised me to, I would get a free vaccine to prevent the disease would you say you…

95% CI


Total 800 Strongly agree 45 40 49 Agree 48 43 52 Disagree 6 4 9 Strongly disagree 1 1 3

East 402 Strongly agree 37 32 42 Agree 56 50 61 Disagree 6 4 9 Strongly disagree 1 1 3

West 398 Strongly agree 47 41 52 Agree 46 40 51 Disagree 6 4 9 Strongly disagree 1 1 3

If health officials asked me to, I would stay home for a week, without outside visitors, to avoid spreading the disease, would you say you…

95% CI


Total 811 Strongly agree 48 43 52 Agree 45 41 50 Disagree 6 4 9 Strongly disagree 1 1 2

East 407 Strongly agree 41 36 46 Agree 50 45 55 Disagree 7 5 11 Strongly disagree 2 1 4

West 404 Strongly agree 49 44 54

Agree 44 39 49 Disagree 6 4 9 Strongly disagree 1 0 2

Appendix A

Technical Documentation & Questionnaire

Williamson County and Cities Health District

Survey

Technical Report

For:

Williamson County and Cities Health District

Contact: Karen Wilson, MN, MPH

512-930-4387 [email protected]

Presented by: Clearwater Research, Inc.

1845 S. Federal Way Boise, ID 83705

www.clearwater-research.com

Contacts: Teresa Plummer, B.S.

(208) 376-3376, ext. 437 Fax: (208) 376-2008

Email: [email protected]

Date: August 2004

Appendix A, Page 1

Contents

INTRODUCTION ......................................................................................................................................- 1 -

SURVEY INSTRUMENT...........................................................................................................................- 1 -

SAMPLE DESIGN ....................................................................................................................................- 1 -

DATA COLLECTION................................................................................................................................- 2 - FINAL DISPOSITIONS ............................................................................................................................... - 2 -

DATA PREPARATION AND ANALYSIS.................................................................................................- 2 -

ATTACHMENT A: CATI QUESTIONNAIRE............................................................................................- 4 -

ATTACHMENT B: NON-QUESTIONNAIRE VARIABLES IN FINAL DATA SET .................................- 27-

Introduction In this research project, Williamson County & Cities Health District examined health patterns of Williamson County residents using a questionnaire composed largely of BRFSS items. Clearwater Research, Inc., provided sample design, questionnaire consultation, data collection, and data preparation services for the Williamson County & Cities Health District Survey. This report provides technical information regarding those services. Survey Instrument Clearwater Research collaborated with the Williamson County & Cities Health District to refine the study questionnaire. Clearwater provided recommendations regarding question wording and also corrected and added skip patterns within the questionnaire. The questionnaire is presented in Attachment A. Sample Design The 2004 Behavioral Risk Factor Surveillance System (BRFSS) random digit-dialing (RDD) method was used to obtain a probability sample of the noninstitutionalized adult (18 years and older) population in Williamson County. This method uses a sample frame that includes all telephone numbers serving households in the geographic target areas. This RDD method involves disproportationate stratification (DSS), dividing the telephone number sampling frame into listed and unlisted telephone numbers. The listed number stratum is sampled at a rate 1.5 times the rate for unlisted numbers, which improves the sample efficiency (ratio of sample records to completed interviews) compared with an unstratified RDD approach. The sample size goal (800) was exceeded by 27 completed interviews.

Appendix A, Page 2

The required 800 completed interviews were divided evenly among two regions of Williamson County, East Williamson County and West Williamson County (please see Attachment A for a breakdown of the zip codes that comprised each region). Data Collection Clearwater Research conducted interviews between June 20, 2004 and August 6, 2004. The average interview length was 15 minutes. Interviewer performance was closely monitored throughout the field period to assure data quality. Sampled telephone numbers were called according to a schedule designed to minimize bias problems associated with difficult-to-reach respondents. Each sample record was resolved by attempting it a minimum of 15 times during the calling period or until a final disposition code (such as “completed interview” or “disconnected/nonworking number”) was assigned. The calling occasions for the project were weekdays, weekday evenings and weekends. However, the number of weekday calls were restricted in order to maximize the chance of reaching potential respondents. Final Dispositions At the close of the field period, each sampled telephone number was assigned a final disposition that summarizes the separate outcomes of each call attempt for that number. The final dispositions for the Williamson County & Cities Health District Survey sample are presented in Table 1. A total of 827 interviews were completed during the field period. Table 1. Final Dispositions

Disposition Description Records 1 Completed interview 8272 Refused interview, selected respondent 2193 Refused interview, no selected respondent 10514 Disconnected / non-working number 44765 Not a private residence 12516 No eligible respondent at this number 287 Selected respondent not available during the interviewing period 2428 Language barrier 149 Interview terminated within questionnaire 44

10 Communication barrier 2111 Technological barrier 28012 No answer / busy / answering machine 73613 Out of study area 1661

Total 10850 Data Preparation and Analysis Survey data were entered and automatically consolidated into a CATI database as the interviews were being conducted. At the conclusion of data collection, interviewer errors previously documented on data change forms were corrected in the data set using CI3 data editing capabilities. Clearwater Research then implemented a comprehensive routine of data preparation. Data were converted from the CATI database and formatted for review and

Appendix A, Page 3

analysis in SPSS, a statistical analysis software package. Data were thoroughly checked and verified as necessary to correct any potential errors or out-of-range values. In addition, open-ended responses were examined and cleaned for overall comprehension. Open-ends cleaning involved correcting spelling, putting responses into sentence text, and sorting responses into a logical order. Responses to all open-ended questions are included in a separate MS Excel file as well as a text file version. This file includes the cleaned open-ended responses as well as the following information: RESPNUM (which allows for linking back to the data), the question, and the open ended response. A listing of non-questionnaire variables included in the final data set is presented in Attachment B.

Appendix A, Page 4

Attachment A: CATI Questionnaire

Williamson County & Cities Health District INTROQ

HELLO, I’m calling for the Williamson County & Cities Health District, the local health department in Williamson County. My name is (name) . We're gathering information on the health of Williamson County residents. Your phone number has been chosen randomly, and I'd like to ask some questions about health and health practices. Is this XXX-XXX-XXXX? 1. Correct Number (Proceed to next question) 2. Number is not the same – SKIP TO WRONGNUM PRIVRES

Is this a private residence? 1. Yes, continue. 2. No, non-residential – SKIP TO NONRES NONRES – ONLY GET THIS IF PRIVRES = 2 (NON-RESIDENTIAL) Thank you very much, but we are only interviewing private residences. (Disp 25)

WRONGNUM – ONLY GET THIS IF INTROQ = 2 (NUMBER IS NOT THE SAME) Thank you very much, but it I seem to have dialed the wrong number. It’s possible that your number may be called at a later time.

COUNTY

What county do you live in?

__ __ __ FIPS county code (Williamson=491) 777. DON’T KNOW / NOT SURE

999. REFUSED If Fips code !=491 skip to Out of area 1. ZIP—ONLY GET IF COUNTY =491 OR 777 OR 999

What is the zip code where you live? _ _ _ _ _ Enter zip code

77777 DON’T KNOW / NOT SURE

99999 REFUSED

Appendix A, Page 5

CONTINUE IF Region =1 and ZIP = 78634, 76511, 76530, 76574, 76578, 76577,78615, 78621. OTHER ZIPS = Out of area 2 . CONTINUE IF Region =2 and ZIP =76527, 76537, 78626, 78627, 78628, 78642, 78673, 78674, 76573, 78613, 78630, 78641, 78646, 78651, 78664, 78680, 78681, 78683, 78717, 78727, 78728, 78729. OTHER ZIPS = Out of area 2 .

Out of area 1 ONLY GET IF COUNTY<>491 AND <>777 AND <>999 I’m sorry, but we are only interviewing residents of Williamson County. Thank you for your time. Good bye. (Terminate) (Disp 37) Out of area 2

I’m sorry, but we are only interviewing specific zip codes in Williamson County. Thank you for your time. Good bye. (Terminate) (Disp 37)

ADULTS I need to randomly select one adult who lives in your household to be interviewed. How many members of your household, including yourself, are 18 years of age or older? _ _ ENTER THE NUMBER OF ADULTS

IF ANS = 1 SKIP TO ONEADULT MEN How many of these adults are men? 0. None 1. One 2. Two 3. Three 4. Four 5. Five 6. Six 7. Seven 8. Eight 9. Nine

IF ANS = ADULTS SKIP TO SELECTED WOMEN

How many of these adults are women? 0. None 1. One 2. Two 3. Three 4. Four 5. Five

Appendix A, Page 6

6. Six 7. Seven 8. Eight 9. Nine

IF ANS + MEN = ADULTS SKIP TO SELECTED

WRONGTOT – ONLY GET IF MEN + WOMEN <> ADULTS I’m sorry, something is not right. Number of Men - Number of Women - --------------- Number of Adults –

1. CORRECT THE NUMBER OF MEN 2. CORRECT THE NUMBER OF WOMEN

3. CORRECT THE NUMBER OF ADULTS SELECTED - ONLY GET IF MORE THAN ONE ADULT IN HOUSEHOLD The person in your household I need to speak with is the . Are you the ? 1. YES – SKIP TO YOURTHE1 2. NO – SKIP TO GETNEWAD ONEADULT – ONLY GET THIS IF ONE ADULT IN HOUSEHOLD Are you the adult?

1. YES AND THE RESPONDENT IS A MALE – SKIP TO YOURTHE1

2. YES AND THE RESPONDENT IS A FEMALE – SKIP TO YOURTHE1

3. NO – SKIP TO ASKGENDR ASKGENDER – ONLY GET IF ONEADULT = 3 Is the Adult a man or a woman?

1. Male

2. Female GETADULT - ONLY GET IF ONEADULT = 3 May I speak with him or her?

Appendix A, Page 7

1. YES, ADULT COMING TO THE PHONE 2. NO, GO TO NEXT SCREEN, PRESS F3 AND SCHEDULE A CALL-BACK

***DO NOT USE <F3> ON THIS SCREEN***

YOURTHE1 - ONLY GET IF ONEADULT = 1 (YES) OR IF SELECTED = 1 (YES) Then you are the person I need to speak with. 1. PERSON INTERESTED, CONTINUE – SKIP TO INTROSCR 2. GO BACK TO ADULTS QUESTION. WARNING:A NEW RESPONDENT MAY BE SELECTED

GETNEWAD - ONLY GET IF SELECTED = 2 (NO) May I speak with the ? 1. YES, SELECTED RESPONDENT COMING TO THE PHONE 2. NO, GO TO NEXT SCREEN, PRESS F3 AND SCHEDULE A CALL-BACK 3. GO BACK TO ADULTS QUESTION. WARNING:A NEW RESPONDENT MAY BE SELECTED

***DO NOT USE F3 ON THIS SCREEN*** GETNEWAD - ONLY GET IF SELECTED = 2 (NO) HELLO, I’m __________ calling for the Williamson County & Cities Health District, the local health department in Williamson County. We’re gathering information on the health of Williamson County residents. Your phone number has been chosen randomly to be interviewed, and I’d like to ask some questions about health and health practices. 1. PERSON INTERESTED, CONTINUE – SKIP TO INTROSCR 2. GO BACK TO ADULTS QUESTIONS. WARNING: A NEW RESPONDENT MAY BE SELECTED INTROSCR – ONLY GET IF NEWADULT = 1 OR YOURTHE1 = 1 I won't ask for your name, address, or other personal information that can identify you. You don’t have to answer any question you don’t want to, and you can end the interview at any time. Any information you give to me will be confidential. If you have any questions about this survey, I will provide a telephone number for you to call to get more information. 1. Person interested, continue 2. Go Back to Adults Question. Warning: A New Respondent may be selected NONQAL - ONLY GET IF CATI THINKS THE QUOTACELL IS FULL INTERVIEWER: PLEASE ALERT YOUR SUPERVISOR IMMEDIATELY!!!! THE QUOTAS SET FOR THIS STUDY ARE INCORRECT.

Appendix A, Page 8

AFTER NOTIFYING YOUR SUPERVISOR, RETURN THE RECORD

Health Status [CORE 1, 2004 BRFSS TEXAS]

Q1. EVERYONE

Would you say that in general your health is excellent, very good, good, fair, or poor?

1. Excellent 2. Very good 3. Good 4. Fair 5. Poor 7. DON’T KNOW/NOT SURE 9. REFUSED

Health Days – Health-related Quality of Life [CORE 2, 2004 BRFSS TEXAS]

Q2. EVERYONE

Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?

__ __ Number of days 88. NONE 77. DON’T KNOW/NOT SURE 99. REFUSED

Q3. EVERYONE

Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?


Q4. – ONLY GET IF Q02 <> 88 OR Q03 <> 88 During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?


Appendix A, Page 9

Health Care Access [CORE 3, 2004 BRFSS TEXAS]

Q5. EVERYONE

Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?

1. Yes

2. No 7. DON’T KNOW/NOT SURE 9. REFUSED

Q6. EVERYONE

Do you have one person you think of as your personal doctor or health care provider? (If “No,” ask: “Is there more than one or is there no person who you think of?”)

1. Yes, only one 2. More than one

3. No 7. DON’T KNOW/NOT SURE 9. REFUSED

Q7. EVERYONE

Was there a time in the past 12 months when you needed to see a doctor but could not because of the cost?

1. Yes 2. No 7. DON’T KNOW/NOT SURE 8. REFUSED

Tobacco Use [CORE 7, 2004 BRFSS TEXAS]

Q8. EVERYONE Have you smoked at least 100 cigarettes in your entire life? NOTE: 5 packs = 100 cigarettes 1. Yes 2. No – SKIP TO Q11

Appendix A, Page 10

7. DON’T KNOW / NOT SURE – SKIP TO Q11 9. REFUSED – SKIP TO Q11

Q9. – ONLY GET IF Q8=1

Do you now smoke cigarettes every day, some days, or not at all?

1. Everyday 2. Some days 3. Not at all – SKIP TO Q11 9. REFUSED – SKIP TO Q11

Q10. – ONLY GET IF Q9<3 During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?

1. Yes 2. No 7. DON’T KNOW / NOT SURE 9. REFUSED

Other Tobacco Products [MODULE 14, 2004 BRFSS TEXAS]

Q11. EVERYONE Have you ever used or tried any smokeless tobacco products such as chewing tobacco or snuff?

1. Yes

2. No – SKIP TO Q13

7. DON’T KNOW/ NOT SURE – SKIP TO Q13 9. REFUSED – SKIP TO Q13

Q12. ONLY GET IF Q11=1

Do you currently use chewing tobacco or snuff every day, some days, or not at all?

1. Every day 2. Some days 3. Not at all

7. DON’T KNOW/ NOT SURE 9. REFUSED

Appendix A, Page 11

Diabetes [CORE 10, 2004 BRFSS TEXAS]

Q13. EVERYONE These next questions are about a variety of general health topics. Have you ever been told by a doctor that you have diabetes? (If “Yes” and respondent is female, ask: “Was this only when you were pregnant?” - If Respondent says pre-diabetes or borderline diabetes, use response code 4.)

1. Yes 2. Yes, but female told only during pregnancy 3. No 4. No, pre-diabetes or borderline diabetes 7. DON’T KNOW / NOT SURE 9. REFUSED

Q13V. ONLY GET IF Q13=2 AND RESP IS MALE

INTERVIEWER: You recorded that the respondent was told by a doctor during pregnancy that she had diabetes. Are you sure? The respondent selected was the Is the previous answer correct?

Hypertension Awareness [MODULE 3, 2004 BRFSS DRAFT]

Q14. EVERYONE

Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure? (If “Yes” and respondent is female, ask: “Was this only when you were pregnant?”) 1. Yes 2. Yes, but female told only during pregnancy SKIP TO Q16 3. No SKIP TO Q16 7. DON’T KNOW / NOT SURE SKIP TO Q16 9. REFUSED SKIP TO Q16

Q14V. ONLY GET IF Q14=2 AND RESP IS MALE INTERVIEWER: You recorded that the respondent was told by a health professional during pregnancy that she had high blood

Appendix A, Page 12

pressure. Are you sure? The respondent selected was the Is the previous answer correct?


Are you currently taking medicine for your high blood pressure?


Cholesterol Awareness [MODULE 4, 2004 BRFSS DRAFT]

Q16. EVERYONE

Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked?


Q17. Only ask if Q16=1

About how long has it been since you last had your blood cholesterol checked? Read only if necessary 1. Within the past year (anytime less than 12 months ago) 2. Within the past 2 years (1 year but less than 2 years ago) 3. Within the past 5 years (2 years but less than 5 years ago) 4. 5 or more years ago 7. DON’T KNOW / NOT SURE 9. REFUSED


Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?

1. Yes 2. No 7. DON’T KNOW / NOT SURE

Appendix A, Page 13

9. REFUSED

Adult Asthma

[CORE 9, 2004 BRFSS TEXAS]

Q19. EVERYONE

Have you ever been told by a doctor, nurse or other health professional that you had asthma?

1. Yes 2. No – SKIP TO Q21


Q20. - ONLY GET IF Q19=1

Do you still have asthma? 1. Yes 2. No

7. DON’T KNOW / NOT SURE 9. REFUSED

Oral Health [CORE 11, 2004 BRFSS TEXAS]

Q21. EVERYONE

How long has it been since you last visited a dentist or a dental clinic for any reason?

NOTE: Include visits to dental specialists, such as orthodontists PLEASE READ: 1. Within the past year (anytime less than 12 months ago) 2. Within the past 2 years (1 year but less than 2 years ago) 3. Within the past 5 years (2 years but less than 5 years ago) 4. 5 or more years ago

8. NEVER 7. DON’T KNOW / NOT SURE 9. REFUSED

Appendix A, Page 14

Immunization [CORE 12, 2004 BRFSS TEXAS]

Q22. EVERYONE

During the past 12 months, have you had a flu shot? IF NECESSARY: We want to know if you had a flu shot injected in your arm. 1. Yes 2. No


Q23. EVERYONE

During the past 12 months, have you had a flu vaccine that was sprayed in your nose? 1. Yes 2. No


Fruits and Vegetables

[Section 11, Travis County STEPS Survey]

Q24. EVERYONE These next questions are about the foods you usually eat or drink. Please tell me how often you eat or drink each one, for example, twice a week, three times a month, and so forth. Remember, I am only interested in the foods you eat. Include all foods you eat, both at home and away from home. How often do you drink fruit juices such as orange, grapefruit, or tomato?

1__ __ Per day 2__ __ Per week 3__ __ Per month 4__ __ Per year 888. NEVER 777. DON’T KNOW / NOT SURE 999. REFUSED

Q25. EVERYONE

Not counting juice, how often do you eat fruit?

Appendix A, Page 15


Q26. EVERYONE

How often do you eat green salad? 1__ __ Per day 2__ __ Per week 3__ __ Per month 4__ __ Per year 888. NEVER 777. DON’T KNOW / NOT SURE 999. REFUSED

Q27. EVERYONE

How often do you eat potatoes not including French fries, fried potatoes, or potato chips?


Q28. EVERYONE

How often do you eat carrots? 1__ __ Per day 2__ __ Per week 3__ __ Per month 4__ __ Per year 888. NEVER 777. DON’T KNOW / NOT SURE 999. REFUSED

Q29. EVERYONE

Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat?

Appendix A, Page 16

(Example: A serving of vegetables at both lunch and dinner would be two servings.) 1__ __ Per day 2__ __ Per week 3__ __ Per month 4__ __ Per year 888. NEVER 777. DON’T KNOW / NOT SURE 999. REFUSED

Demographics

[CORE 13, 2004 BRFSS TEXAS]

Q30. EVERYONE

What is your age?

__ __ Enter age in years


Q31. EVERYONE

Are you Hispanic or Latino?

1. Yes

1. No 7. DON’T KNOW / NOT SURE 9. REFUSED

Q32. EVERYONE

Which one of these groups would you say best represents your race?

1. White 2. Black or African American 3. Asian 4. Native Hawaiian or Other Pacific Islander 5. American Indian, Alaska Native or

6. Other [specify]______________


Q33. EVERYONE

Are you married, divorced, widowed, separated, never married, or a member of an unmarried couple?

Please read:

Appendix A, Page 17

1. Married 2. Divorced

3. Widowed 4. Separated 5. Never married

6. A member of an unmarried couple 9. REFUSED

Q34. EVERYONE

How many children less than 18 years of age live in your household?

__ __ Number of children 88. NONE 99. REFUSED

Q35. EVERYONE

What is the highest grade or year of school you completed?

Read only if necessary:

1. Never attended school or only attended kindergarten 2. Grades 1 through 8 (Elementary) 3. Grades 9 through 11 (Some high school) 4. Grade 12 or GED (High school graduate) 5. College 1 year to 3 years (Some college or technical school) 6. College 4 years or more (College graduate) 9. REFUSED

Q36. EVERYONE

Are you currently: employed for wages, self-employed, out of work for more than 1 year, out of work for less than 1 year, a homemaker, a student, retired, or unable to work?

1. Employed for wages 2. Self-employed 3. Out of work for more than 1 year 4. Out of work for less than 1 year 5. A Homemaker 6. A Student 7. Retired 8. Unable to work

9. REFUSED

Q37. EVERYONE

Is your annual household income from all sources?

Appendix A, Page 18

1. Less than $10,000 2. Less than $15,000 ($10,000 to less than $15,000) 3. Less than $20,000 ($15,000 to less than $20,000) 4. Less than $25,000 ($20,000 to less than $25,000) 5. Less than $35,000 ($25,000 to less than $35,000) 6. Less than $50,000 ($35,000 to less than $50,000) 7. Less than $75,000 ($50,000 to less than $75,000) 8. $75,000 or more 77. DON’T KNOW/NOT SURE 99. REFUSED

Q38. EVERYONE

About how much do you weigh without shoes?

Round fractions up __ __ __ Weight (pounds) 9__ __ __ Weight (kilograms)


Q39. EVERYONE

About how tall are you without shoes?

Round fractions down __ __ __ Height ft/inches (Ex. 5 feet 9 inches = 509) 9 __ __ __ Height meters/centimeters


Q40. EVERYONE

Do you have more than one telephone number in your household? Do not include cell phones or numbers that are only used by a computer or fax machine.



Q41. – ONLY GET IF Q40=1

How many of these phone numbers are residential numbers?

__ Residential telephone numbers [6=6 or more]


Appendix A, Page 19

Q42. EVERYONE

Indicate sex of respondent. Ask only if necessary.

1. Male 2. Female

GENDER CHECK

Childhood Asthma [MODULE 10, 2004 BRFSS TEXAS]

Q43. – ONLY GET IF Q34 <>88 AND Q34<>99

Earlier you said there were [fill in number from Q34] children age 17 or younger living in your household. How many of these children have ever been diagnosed with asthma?

_ _ Number of children

88. NONE – SKIP TO Q45 77. DON’T KNOW/ NOT SURE – SKIP TO Q45 99. REFUSED – SKIP TO Q45

Q44. – ONLY GET IF Q43 <77

Does this child/how many of these children still have asthma? If only one child from Q34 and response is “Yes” to this question, code ‘01’. If response is “No,” code as ’88.”

_ _ Number of children 88. NONE 77. DON’T KNOW/ NOT SURE 99. REFUSED

Physical Activity [STATE ADDED 4, 2004 BRFSS TEXAS]

Q45. ONLY GET IF Q36=2 OR Q36=1

When you are at work, which of the following best describes what you do? Would you say… 1. Mostly sitting or standing 2. Mostly walking 3. Mostly heavy labor or physically demanding work. 7. DON'T KNOW / NOT SURE 9. REFUSED

Appendix A, Page 20

Q46. EVERYONE We are interested in two types of physical activity – vigorous and moderate. Vigorous activities cause large increases in breathing or heart rate while moderate activities cause small increases in breathing or heart rate.

Now, thinking about the moderate activities you do [fill in (when you are not working,) if Q36=1 OR Q36=2] in a usual week, do you do moderate activities for at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening, or anything else that causes some increase in breathing or heart rate?



Q47. – ONLY GET IF Q46=1 How many days do you do these moderate activities for at least 10 minutes? _ Days per week

77. DON’T KNOW / NOT SURE - SKIP TO Q49 88. DO NOT DO ANY MODERATE PHYSICAL ACTIVITY FOR AT LEAST 10 MINUTES AT A TIME –SKIP TO Q49

99. REFUSED - SKIP TO Q49

Q48. – ONLY GET IF Q47<77 On days when you do moderate activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities? _ _ _ Hours and minutes per day


Q49. EVERYONE

Now, thinking about the vigorous activities you do [fill in (when you are not working) if “employed” or “self-employed”] in a usual week, do you do vigorous activities for at least 10 minutes at a time, such as running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate?



Q50. – ONLY GET IF Q49=1 How many days do you do these vigorous activities for at least 10 minutes? _ Days per week

Appendix A, Page 21

77. DON’T KNOW / NOT SURE - SKIP TO Q52 88. DO NOT DO ANY MODERATE PHYSICAL ACTIVITY FOR AT LEAST 10 MINUTES AT A TIME – SKIP TO Q52 99. REFUSED - SKIP TO Q52

Q51. – ONLY GET IF Q50<77

On days when you do vigorous activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities? _ _ _ Hours and minutes per day


TV Viewing

[STATE ADDED 5, 2004 BRFSS TEXAS]

Q52. EVERYONE Over the past 30 days, on a typical day, how much time did you spend sitting and watching TV or videos or using a computer outside of work? Would you say…

1. Less than 1 hour 2. 1 hour 3. 2 hours 4. 3 hours 5. 4 hours 6. 5 hours or more 8. You do not watch TV or videos or use computer outside of work. 7. DON'T KNOW / NOT SURE 9. REFUSED

Neighborhood [STATE ADDED 7, 2004 BRFSS TEXAS]

Q53. EVERYONE

I will be asking you some questions about the neighborhood in which you live, followed by some questions about the community in which you live. For the purposes of this interview, neighborhood is defined as the area within one-half mile or a ten-minute walk from you house and community is defined as a 5-mile or 10-mile drive from your house. In general, would you say that the people in your neighborhood are…

1. Very physically active 2. Somewhat physically active 3. Not very physically active 4. Not at all physically active

7. DON’T KNOW/NOT SURE 9. REFUSED

Appendix A, Page 22

Q54. EVERYONE

Overall, how would you rate your neighborhood as a place to walk? Would you say…

1. Very pleasant 2. Somewhat pleasant 3. Not very pleasant 4. Not at all pleasant 7. DON’T KNOW/NOT SURE 9. REFUSED

Q55. EVERYONE

How safe from crime do you consider your neighborhood to be? Would you say…

1. Extremely safe 2. Quite safe 3. Slightly safe 4. Not at all safe 7. DON’T KNOW/NOT SURE 9. REFUSED

Q56. EVERYONE

Does your neighborhood have any sidewalks?

1. Yes 2. No


Q57. EVERYONE Do you use any private or membership only recreation facilities in your community for physical activity?

1. Yes 2. No 3. My community does not have these facilities


Q58. EVERYONE Do you use walking trails, parks, playgrounds, sports fields in your community for physical activity?


7. DON’T KNOW / NOT SURE

Appendix A, Page 23

9. REFUSED

Q59. EVERYONE Do you use any public recreation centers in your community for physical activity?



Q60. EVERYONE Do you use schools that are open in your community for public recreation activities?

1. Yes 2. No 3. Schools in my community are not open for the public to use


Public Health Emergency

Q61. EVERYONE The next questions are about what would happen if there were a health emergency or natural disaster in Williamson County. Does your household have a radio that would work if the power went out?

1 Yes 2 No 7 DON'T KNOW/NOT SURE 9 REFUSED

Q62. EVERYONE

Does your household have a 3-day supply of food for everyone who lives there?

1 Yes 2 No 7 DON'T KNOW/NOT SURE 9 REFUSED

Q63. EVERYONE

Does your household have a 3-day supply of water for everyone who lives there?

A 3-DAY SUPPLY OF WATER IS 1/2 TO 1 GALLON OF WATER PER PERSON PER DAY

1 Yes 2 No

Appendix A, Page 24

7 DON'T KNOW/NOT SURE 9 REFUSED

Q64. EVERYONE

If you believed that you were exposed to a new or dangerous disease, and you wanted more information, where would you go first to get that information? DO NOT READ LIST

01 YOUR DOCTOR'S OFFICE 02 A HOSPITAL OR EMERGENCY ROOM 03 THE WILLIAMSON COUNTY & CITIES HEALTH DISTRICT (THE LOCAL HEALTH DEPARTMENT) 04 A RELATIVE OR FRIEND 05 CALL 911 06 THE TEXAS DEPARTMENT OF HEALTH (THE STATE HEALTH DEPARTMENT) 07 THE INTERNET 08 TV OR RADIO 09 PHARMACIST 10 OTHER (PLEASE SPECIFY) 77 DON'T KNOW/NOT SURE, 99 REFUSED

Q65. EVERYONE

Imagine now that Texas' Governor has declared that a new and dangerous disease is spreading toward Texas. How strongly would you agree or disagree with the following statements? If my doctor or health care provider advised me to, I would get a free vaccine to prevent the disease. Would you say you… READ LIST

1 Strongly Agree 2 Agree 3 Disagree 4 Strongly Disagree 7 DON'T KNOW/NOT SURE 9 REFUSED

Q66. EVERYONE

If health officials asked me to, I would stay at home for a week, without outside visitors, to avoid spreading the disease or catching it. Would you say you… READ LIST

1 Strongly Agree 2 Agree 3 Disagree 4 Strongly Disagree 7 DON'T KNOW/NOT SURE 9 REFUSED

CLOSING EVERYONE That’s my last question. Everyone’s answers will be combined to give us information about the health practices of people in this county. Thank you very much for your time and cooperation.

Appendix A, Page 25

West County Zip Codes 76527 ........Florence 76537 ........Jarrell 78626 ........Georgetown 78627 ........Georgetown 78628 ........Georgetown (also Andice, Sun City) 78642 ........Liberty Hill 78673 ........Walburg 78674 ........Weir 76573 ........Schwertner (PO Box) 78613 ........Cedar Park 78630 ........Cedar Park 78641 ........Leander 78646 ........Leander - Williamson & Travis Counties 78651 ........Mc Neil (PO Box) 78664 ........Round Rock 78680 ........Round Rock (PO Box) 78681 ........Round Rock 78683 ........Round Rock 78717 ........Austin (Brushy Creek) All Williamson 78727 ........Austin- Williamson & Travis Counties 78728 ........Austin- Williamson & Travis Counties 78729 ........Austin (East Anderson Mill)- Williamson & Travis Counties East County Zip Codes 78634 ........Hutto 76511 ........Bartlett- Williamson & Bell Counties 76530 ........Granger 76574 ........Taylor 76578 ........Thrall 76577 ........Thorndale- Williamson & Milam Counties 78615 ........Coupland- Williamson & Travis Counties 78621 ........Elgin- Williamson, Travis, & Bastrop Counties

Appendix A, Page 26

Appendix A, Page 27

Attachment B: Non-Questionnaire Variables in Final Data Set

Variable Description respnum$ Record identifier assigned by CATI programming software. zippy The respondent’s zip code. lang The language in which the interview was conducted (1 = English, 2 = Spanish). Respgend The gender of the respondent (1 = Male, 2 = Female) numadult Number of adults in the household as indicated by the person answering the phone. nummen Number of male adults in the household as indicated by the person answering the

phone. numwomen Number of female adults in the household as indicated by the person answering the

phone. geostr Sampling variable (1= East and 2= West) repnum The replicate number used for sampling purposes. idate Date the interview was completed.

Appendix B

Census 2000 and Williamson County 2004 BRFSS Demographic Data

Appendix B, Page 1

Census 2000 and Williamson County 2004 BRFSS Demographic Data

Williamson

County East

County West

County Census

2000 % % % % Age 18 to 24 10 8 11 11 25 to 34 25 23 25 24 35 to 44 27 23 27 27 45 to 54 16 16 16 18 55 to 64 12 13 12 9 65+ 11 17 9 11 Gender Male 49 50 49 49 Female 51 50 51 51 Race / Ethnicity Hispanic or Latino 16 22 14 15 White 84 76 86 84 Black or African American 4 9 3 5 Asian 2 1 2 3 Native Hawaiian or Other Pacific Islander 0 0 1 0 American Indian, Alaskan Native 1 1 1 0 Other 9 14 8 8 Marital Status Married 69 70 68 64 Divorced 8 7 8 9 Widowed 3 6 3 4 Separated 1 2 1 1 Never Married 15 12 16 21 A member of an unmarried couple¹ 4 4 4 4

¹ Census 2000 data for members of an unmarried couple is from a different dataset, or universe, than marital status. Therefore the percentages will not add up to 100.

Appendix B, Page 2

Williamson

County East West Census

2000 % % % % Children in Household Children > 18 in household: 50 48 50 57 No children > 18 in household: 50 52 50 43 Education Less than high school 8 19 5 11 High school graduate 27 35 25 22 Some college 25 26 25 26 College graduate 40 20 45 40 Employed for Wages 56 57 56 71 Self-employed 10 9 11 -- Out of work for more than 1 year 2 3 2 -- Out of work for less than 1 year 4 4 5 -- Homemaker 9 9 9 -- Student 4 1 5 -- Retired 12 13 11 -- Unable to work 2 4 2 -- Income Less than $10,000 2 3 3 4 $10,000 to less than $15,000 3 7 2 3 $15,000 to less than $20,000 6 9 5 3 $20,000 to less than $25,000 9 10 8 4 $25,000 to less than $35,000 8 11 8 9 $35,000 to less than $50,000 14 18 13 16 $50,000 to less than $75,000 22 24 21 26 $75,000+ 36 16 40 36

Appendix C

Healthy People 2010 Comparative Indicators

Appendix C, Page 1

Healthy People 2010 Comparative Indicators

Diabetes

5-3. Reduce the overall rate of diabetes that is clinically diagnosed.

Target: 25 overall cases per 1,000 population (2.5%)

Baseline: 40 overall cases (including new and existing cases) of diabetes per 1,000 population occurred in 1997 (age adjusted to the year 2000 standard population).

Target setting method: Better than the best (retain year 2000 target).

Data source: National Health Interview Survey (NHIS), CDC, NCHS.

Blood Pressure

12-9. Reduce the proportion of adults with high blood pressure.

Target: 16 percent.

Baseline: 28 percent of adults aged 20 years and older had high blood pressure in 1988–94 (age adjusted to the year 2000 standard population).

Target setting method: Better than the best.

Data source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

Cholesterol

12-14. Reduce the proportion of adults with high total blood cholesterol levels.

Target: 17 percent.

Baseline: 21 percent of adults aged 20 years and older had total blood cholesterol levels of 240 mg/dL or greater in 1988–94 (age adjusted to the year 2000 standard population).



12-15. Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years.

Target: 80 percent.

Baseline: 67 percent of adults aged 18 years and older had their blood cholesterol checked within the preceding 5 years in 1998 (age adjusted to the year 2000 standard population).



Appendix C, Page 2

Weight Status and Growth

19-1. Increase the proportion of adults who are at a healthy weight.

Target: 60 percent.

Baseline: 42 percent of adults aged 20 years and older were at a healthy weight (defined as a body mass index [BMI] equal to or greater than 18.5 and less than 25) in 1988–94 (age adjusted to the year 2000 standard population).



19-2. Reduce the proportion of adults who are obese.

Target: 15 percent.

Baseline: 23 percent of adults aged 20 years and older were identified as obese (defined as a BMI of 30 or more) in 1988–94 (age adjusted to the year 2000 standard population).



Physical Activity in Adults

22-1. Reduce the proportion of adults who engage in no leisure-time physical activity.

Target: 20 percent.

Baseline: 40 percent of adults aged 18 years and older engaged in no leisure-time physical activity in 1997 (age adjusted to the year 2000 standard population).



22-2. Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day.

Target: 50 percent.

Baseline: 15 percent of adults aged 18 years and older engaged in moderate physical activity for at least 30 minutes 5 or more days per week in 1997 (age adjusted to the year 2000 standard population).


Data source:

22-3. Increase the proportion of adults who engage in vigorous physical activity that promotes the development and maintenance of cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.

Target: 30 percent.

Appendix C, Page 3

Baseline: 23 percent of adults aged 18 years and older engaged in vigorous physical activity 3 or more days per week for 20 or more minutes per occasion in 1997 (age adjusted to the year 2000 standard population).



National Health Interview Survey (NHIS), CDC, NCHS.

Food and Nutrient Consumption

19-5. Increase the proportion of persons aged 2 years and older who consume at least two daily servings of fruit.

Target: 75 percent.

Baseline: 28 percent of persons aged 2 years and older consumed at least two daily servings of fruit in 1994–96 (age adjusted to the year 2000 standard population).


Data source: Continuing Survey of Food Intakes by Individuals (CSFII) (2-day average), USDA.

19-6. Increase the proportion of persons aged 2 years and older who consume at least three daily servings of vegetables, with at least one-third being dark green or orange vegetables.

Target: 50 percent.

Baseline: 3 percent of persons aged 2 years and older consumed at least three daily servings of vegetables, with at least one-third of these servings being dark green or orange vegetables in 1994–96 (age adjusted to the year 2000 standard population).


Data source: Continuing Survey of Food Intakes by Individuals (CSFII) (2-day average), USDA.

Tobacco Use in Population Groups

27-1. Reduce tobacco use by adults.

Target and baseline:

1998 Baseline*

2010 Target

Objective Reduction in Tobacco Use by Adults Aged 18 Years and Older

Percent

27-1a. Cigarette smoking 24 12

27-1b. Spit tobacco 2.6 0.4

27-1c. Cigars 2.5 1.2

27-1d. Other products Developmental

*Age adjusted to the year 2000 standard population. Target setting method: Better than the best.


Appendix C, Page 4

Clinical Preventive Care

1-1. Increase the proportion of persons with health insurance.

Target: 100 percent.

Baseline: 83 percent of persons under age 65 years were covered by health insurance in 1997 (age adjusted to the year 2000 standard population).

Target setting method: Total coverage.


Primary Care

1-5. Increase the proportion of persons with a usual primary care provider.

Target: 85 percent.

Baseline: 77 percent of the population had a usual primary care provider in 1996.


Data source: Medical Expenditure Panel Survey (MEPS), AHRQ.

Immunization and Infectious Diseases

14-29. Increase the proportion of adults who are vaccinated annually against influenza and ever vaccinated against pneumococcal disease.

Target and baseline:

Objective Increase in Adults Vaccinated 1998* Baseline 2010 Target

Percent

Noninstitutionalized adults aged 65 years and older

14-29a. Influenza vaccine 64 90

Source: U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health and Objectives for Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. [http://www.healthypeople.gov/Document/tableofcontents.htm#parta]

Documents

2004 Behavioral Risk Factor Surveillance SystemRisk Factor Surveillance System (BRFSS) survey for Williamson County in an effort to assess and understand the health behaviors and associated